Remifentanil and propofol for tracheal intubation without muscle relaxant in children: the effects of ketamine

BACKGROUND AND OBJECTIVERemifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability. METHODSWe studied 88 children (3–12 years) undergoing elective surgery. Group K received ketamine 0.5 mg kg, remifentanil 3 μg kg and propofol 3 mg kg. Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SpO2 were recorded. RESULTSThe intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P < 0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P < 0.05). CONCLUSIONThe addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses.